Late mortality in survivors of autologous hematopoietic-cell transplantation: report from the Bone Marrow Transplant Survivor Study

被引:169
作者
Bhatia, S
Robison, LL
Francisco, L
Carter, A
Liu, Y
Grant, M
Baker, KS
Fung, H
Gurney, JG
McGlave, PB
Nademanee, A
Ramsay, NKC
Stein, A
Weisdorf, DJ
Forman, SJ
机构
[1] City Hope Canc Ctr, Duarte, CA 91010 USA
[2] Univ Minnesota, Minneapolis, MN USA
[3] Fred Hutchinson Canc Res Ctr, Seattle, WA 98104 USA
[4] Univ Calif Irvine, Irvine, CA 92717 USA
关键词
D O I
10.1182/blood-2005-01-0035
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
We assessed late mortality in 854 individuals who had survived 2 or more years after autologous hematopoietic cell transplantation (HCT) for hematologic malignancies. Median age at HCT was 36.5 years, and median length of follow-up was 7.6 years. Overall survival was 68.8% +/- 1.8% at 10 years, and the cohort was at a 13-fold increased risk for late death (standardized mortality ratio [SMR] = 13.0) when compared with the general population. Mortality rates approached those of the general population after 10 years among patients at standard risk for relapse at HCT (SMR = 1.1) and in patients undergoing transplantation for acute myeloid leukemia (AML; SMR = 0.9). Relapse of primary disease (56%) and subsequent malignancies (25%) were leading causes of late death. Relapse-related mortality was increased among patients with Hodgkin disease (HD; relative risk [RR] = 3.6), non-Hodgkin lymphoma (NHL; RR = 2.1), and acute lymphoblastic leukemia (ALL; RR = 6.5). Total body irradiation (RR = 0.6) provided a protective effect. Nonrelapse-related mortality was increased after carmustine (RR = 2.3) and with use of peripheral blood stem cells (RR = 2.4). Survivors were more likely to report difficulty in holding jobs (RR = 9.4) and in obtaining health (RR = 7.7) or life insurance (RR = 8.4) when compared with siblings. Although mortality rates approach that of the general population after 10 years in certain subgroups, long-term survivors of autologous HCT continue to face challenges affecting their health and well-being.
引用
收藏
页码:4215 / 4222
页数:8
相关论文
共 49 条
  • [1] Ager S, 1996, BONE MARROW TRANSPL, V17, P335
  • [2] Pulmonary toxicity following carmustine-based preparative regimens and autologous peripheral blood progenitor cell transplantation in hematological malignancies
    Alessandrino, EP
    Bernasconi, P
    Colombo, A
    Caldera, D
    Martinelli, G
    Vitulo, P
    Malcovati, L
    Nascimbene, C
    Varettoni, M
    Volpini, E
    Klersy, C
    Bernasconi, C
    [J]. BONE MARROW TRANSPLANTATION, 2000, 25 (03) : 309 - 313
  • [3] ANDRYKOWSKI MA, 1989, BONE MARROW TRANSPL, V4, P75
  • [4] THE QUALITY OF LIFE IN ADULT SURVIVORS OF ALLOGENEIC BONE-MARROW TRANSPLANTATION - CORRELATES AND COMPARISON WITH MATCHED RENAL-TRANSPLANT RECIPIENTS
    ANDRYKOWSKI, MA
    ALTMAIER, EM
    BARNETT, RL
    OTIS, ML
    GINGRICH, R
    HENSLEEDOWNEY, PJ
    [J]. TRANSPLANTATION, 1990, 50 (03) : 399 - 406
  • [5] [Anonymous], 1987, Statistical methods in cancer research, Vol 1-The analysis of case-control studies
  • [6] APPELBAUM FR, 1978, BLOOD, V52, P85
  • [7] New malignancies after blood or marrow stem-cell transplantation in children and adults: Incidence and risk factors
    Baker, KS
    Defor, TE
    Burns, LJ
    Ramsay, NKC
    Neglia, JP
    Robison, LL
    [J]. JOURNAL OF CLINICAL ONCOLOGY, 2003, 21 (07) : 1352 - 1358
  • [8] Malignant neoplasms following bone marrow transplantation
    Bhatia, S
    Ramsay, NKC
    Steinbuch, M
    Dusenbery, KE
    Shapiro, RS
    Weisdorf, DJ
    Robison, LL
    Miller, JS
    Neglia, JP
    [J]. BLOOD, 1996, 87 (09) : 3633 - 3639
  • [9] Solid cancers after bone marrow transplantation
    Bhatia, S
    Louie, AD
    Bhatia, R
    O'Donnell, MR
    Fung, H
    Kashyap, A
    Krishnan, A
    Molina, A
    Nademanee, A
    Niland, JC
    Parker, PA
    Snyder, DS
    Spielberger, R
    Stein, A
    Forman, SJ
    [J]. JOURNAL OF CLINICAL ONCOLOGY, 2001, 19 (02) : 464 - 471
  • [10] Cardiac and pulmonary toxicity in patients undergoing high-dose chemotherapy for lymphoma and breast cancer: prognostic factors
    Brockstein, BE
    Smiley, C
    Al-Sadir, J
    Williams, SF
    [J]. BONE MARROW TRANSPLANTATION, 2000, 25 (08) : 885 - 894